Well, it’s something that directly affects around 50% of the population – and impacts on others too. And when you’re part of a community that has an older demographic, it’s going to feel like more! In this blog, Deborah Lancastle talks about the menopause and approaches to managing it.
The menopause happens between the ages of 45 and 55 Menopause – NHS (www.nhs.uk), although surgery or certain medical treatments can cause you to become menopausal at an earlier age. The menopause involves a progression towards your ‘last period’ over the course of several years, and during these years you might experience periods that are irregular, last for different lengths of time, and vary in flow. The criteria below (based on the Stages of Reproductive Aging Workshop [STRAW] criteria, e.g., Soules et al., 2001) provide a helpful way of working out where you are in the menopause transition.
| Premenopause | I do not have menopausal symptoms yet, and I continue to have periods as usual. |
| Perimenopause – Early Phase | I am currently experiencing menopausal symptoms. I have regular monthly periods, but the length or flow of each period varies. |
| Perimenopause – Late Phase | I am experiencing menopausal symptoms and have not gone 12 months in a row without a period, but I sometimes have more than 2months between periods. |
| Postmenopause – symptomatic | I haven’t had a period in over 12 months and continue to have menopausal symptoms. |
| Postmenopause – asymptomatic | I haven’t had a period in over 12 months and I no longer have (or never had) menopausal symptoms. |
| Surgical menopause | I’ve had an oophorectomy [ovary or ovaries removed] or hysterectomy [womb removed] that caused me to go through the menopause. |
However, even this guidance might not help if you have had certain kinds of medical treatment or have health issues that impact on your periods. Some contraceptives and other medications can stop your periods and sometimes your periods will stop if you are very underweight or overweight. Or, you might always have had irregular periods with long gaps between them! Consulting your GP if you are unsure could help to confirm whether any symptoms you are experiencing could be due to the menopause.
The menopause and life:
When you look at the age range for the menopause, it is clear that this transition occurs at a time of life which can be pretty ‘full on’ for many of us. If you have ever had children, they could well be teenagers or young adults, and you might even have a grandchild or two! In addition, you might have elderly parents who need your help and support. Added to that, if you are working, you could be making leaps in career progression or be thinking that you seem to be passed over when new work opportunities become available. Or perhaps you have now retired! You might be loving the freedom or maybe you’re unexpectedly feeling a bit bored and listless without your job to bring structure to your week. Physically, you might feel full of life and vitality, or maybe aches and health conditions are causing you trouble. Every woman’s life during the menopause will be different! But when you add the demands of your daily life to any of the many symptoms linked to the menopause, it is no surprise if you feel overwhelmed and fed up.
It’s not all about hot flushes! Tracking your symptoms:
Recent research by Dr Robin Andrews (Andrews, John & Lancastle, 2023) included a list of 30 physical and 20 emotional symptoms experienced during the menopause. The physical symptoms were adapted from Health & Her ‘s (2019) online symptom checker (Perimenopause & Menopause Symptom Checker | Health & Her (healthandher.com) and the emotional symptoms from the Boivin and Takefman (1995) Daily Record Keeping Sheet. Robin conducted a trial where one group of women monitored their symptoms every day for two weeks, and the other group monitored their symptoms once at the beginning of the fortnight, and once at the end. The lists of symptoms that were rated are below.
| Emotional symptom | 0+ Not at all You have not experienced this symptom or emotion in the last 24 hours | 1= Mild You have, but it has not impacted your daily activities or made you feel any different than usual | 2 =Moderate You have and it has impacted your daily activities to some degree or made you feel somewhat different than usual | 3= Severe You have and it has heavily impacted your daily activities or made you feel extremely different than usual |
|---|---|---|---|---|
| Nervous | ||||
| Positive | ||||
| Relieved | ||||
| Sad | ||||
| Hopeful | ||||
| Confident | ||||
| Disappointed | ||||
| Happy | ||||
| Discouraged | ||||
| Anxious | ||||
| Isolated | ||||
| Content | ||||
| Tense | ||||
| Rejected | ||||
| Fulfilled | ||||
| Left out | ||||
| Lonely | ||||
| Encouraged | ||||
| Angry | ||||
| Worried | ||||
Robin’s research showed that daily monitoring improved physical symptoms, negative emotional symptoms, and loneliness. The group that monitored every day reported much less severe symptoms at the end of two weeks than they did at the beginning, compared to the group who only rated their symptoms at the beginning and end. Interestingly, although the daily monitoring group reported less loneliness, women in both groups said that being in the study and observing their symptoms helped them to feel less lonely. It seems that simply realising other women ‘out there’ were experiencing similar symptoms helped them feel less alone:
So why might monitoring your symptoms help you feel better? This is an interesting question! One explanation is that rating symptoms allows you to work out patterns and alerts you to seek help. Another explanation is that noting when symptoms change allows you to ‘play detective’ and link the changes to what you have been doing. For example, if you noticed a spike after eating certain foods, or a decrease after certain activities, you might find altering your behaviour and choices improves your wellbeing! Robin won an Audrey Jones Memorial Prize for this important work on menopausal symptom monitoring!
One point worth emphasising is that many of the above symptoms are ‘nonspecific’ symptoms, which means that they can also be symptoms of other conditions, such as mental health problems, thyroid problems, heart problems and so on. Therefore, it is important that you don’t assume that the symptoms you experience are ‘just’ due to the menopause and that you seek help if you are worried. One benefit of monitoring symptoms is that you can go to the doctor armed with information about how often you experience symptoms and how bad they are, which can help the doctor in their decisions about what could be wrong. Why not give monitoring a try?
Deborah Lancastle
Dr Deborah Lancastle is a Principal Lecturer at the University of South Wales. She is a Health and Care Professions Council registered Health Psychologist, British Psychological Society (BPS) Chartered Psychologist and BPS registered Applied Psychology Practice Supervisor, Associate Fellow of the BPS and Fellow of the Higher Education Academy. She is an expert on the psychosocial aspects of women’s reproductive health and all-round kind person for writing this blog for us. Thank you!